Research Findings

More Doctors Need to Learn to Spot Skin Cancers

Too few resident physicians have been trained in skin cancer examinations or watched or practiced the procedure, U.S. researchers report.

In a survey of 342 resident physicians in family medicine, obstetrics and gynecology, pediatrics and internal medicine, researchers collected information on the participants’ training and experience with skin cancer exams as well as their level of skill in performing the exams.

“Clinical training for the skin cancer examination during residency was infrequent,” wrote Dr. Emily Wise, of the Boston University School of Medicine, and colleagues. “During residency, 75.8 percent were never trained in the skin cancer examination, 55.3 percent never observed a skin cancer examination and 57.4 percent never practiced the examination. Only 15.9 percent of residents reported being skilled in the skin cancer examination.”

The researchers found that performing four skin cancer examinations (about one per year of residency) was associated with improvements in skill levels reported by the respondents.

The findings are published in the October issue of the Archives of Dermatology.

Melanoma is the second-most common cause of cancer in Americans aged 15 to 29. About one-quarter of melanomas are detected by doctors, rather than patients. Skin cancers discovered by doctors are generally thinner and have a better prognosis, according to background information in the study.

“Visits to internists and family practitioners make up an estimated 40 percent of physician visits in the United States, and nearly two-thirds of patients with melanoma report a physician visit in the year before diagnosis. Primary-care physicians are thus ideally suited to screen and triage high-risk patients and those with suspicious lesions,” the study authors wrote.

“Residency programs and medical schools may have neither the time nor the infrastructure to teach an expert, comprehensive examination to all physicians in training,” they concluded. “However, the basic ability to recognize potentially suspicious lesions and triage persons with such lesions should be a vital and key component of both training programs. If current physicians in training do not learn this skill set in medical school or residency, there is a low likelihood that they will acquire this knowledge in their day-to-day practice, which could have potentially devastating consequences for melanoma recognition going forward.”